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OB 312 > Physiological Changes of Pregnancy > Flashcards

Physiological Changes of Pregnancy Flashcards

1
Q

Trimesters

A

> > 1 pregnancy = 9 calendar months=10 lunar months = 280 days

> > First Trimester– from LMP through week 13

> > Second Trimester– week 14 through 26

«Third Trimester– week 27 through 40

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2
Q

Gestation

A

The # of weeks since the 1st day of LMP

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3
Q

Abortion

A

> > Birth the occurs before the 20th week of gestation

  • Also referred to as “Termination Pregnancy”
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4
Q

Term

A

The normal duration of pregnancy

> > 37-42 weeks

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5
Q

Antepartum

A

The time between conception and the onset of labor.

> > AKA Prenatal

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6
Q

Intrapartum

A

The time from the onset of true labor until the birth of the placenta.

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7
Q

Postpartum

A

The time from the birth of the placenta until the woman’s body returns to pre-pregnant condition.

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8
Q

Pre-term of Premature Labor

A

Labor that occurs after 20 weeks, BUT before 37 weeks

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9
Q

Post-term of Post-term Labor

A

Labor that occurs after 42 weeks

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10
Q

Stillbirth

A

Infants born death after 20 weeks gestation.

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11
Q

Viability

A

> Capacity to live outside the uterus
About 22 to 24 weeks gestation
Fetal weight > 500 grams

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12
Q

Funic Souffle

A

> A sound made by blood rushing through the umbilical vessels

> Synchronous with the fetal heart rate

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13
Q

Uterine Souffle

A

> Sound made by blood in the uterine arteries

> Synchronous with the maternal heart rate

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14
Q

Terms of Pregnancy

A

Gravida
Any pregnancy, regardless of duration

Nulligravida
Never been pregnant

Primigravida
Pregnant for the first time

Multigravida
In her second or subsequent pregnancy

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15
Q

More Terms

A

> Para
– Birth after 20 weeks, regardless of outcome
– Does not count infants, just births

> Nullipara
– No births after 20 weeks gestation

> Primipara
– One birth at more than 20 weeks gestation

> Multipara
– More than one birth after 20 weeks gestation

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16
Q

Sami Jo is pregnant for the second time. She is 22 weeks pregnant. Her first pregnancy ended at 19 weeks due to an incompetent cervix. She would be termed a:

A

Multigravida

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17
Q

Billi Jean has just delivered her first baby at 38 weeks gestation. The OB nurse will refer to her as a:

A

Primipara

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18
Q

Gravida

A

of Infants

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19
Q

Two methods used for documenting Gravida/Para

A

> Gravida/ Para/ Ab

> GTPAL

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20
Q

GTPAL

A

G = Gravida
T = Term
P = Preterm
A = Abortion
L = Living Child (children)

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21
Q

Pregnancy Test

A

> Serum or Urine tests:
– Human Chorionic Gonadotropin (hCG) hormone
—Earliest biochemical marker for pregnancy

> Pregnancy tests are based on the recognition of hCG or a beta subunit of hCG

> > Production of the beta subunit begins as early as the day of implantation

> > Can be detected as early as 7–10 days after conception

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22
Q

Human Chorionic Gonadotropin

A

Produced by the products of conception until
- placenta is developed 12-14 wks

Preserves the function of the ovarian corpus luteum
Ensures a continued supply of estrogen and progesterone (before the placenta can begin production of estrogen & progesterone)

Miscarriage occurs if the corpus luteum stops functioning before the placenta can begin production of estrogen and progesterone

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23
Q

HCG levels

A

> The peak between 60–70 days after conception

> Higher than normal levels of hCG may be seen with:

> > Hydatidiform Mole (Molar) Pregnancy
Ectopic Pregnancy
Abnormal gestation (Down Syndrome)
Multiple gestation

> An abnormally slow increase or a decrease in hCG may indicate an impending miscarriage

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24
Q

Hormones during pregnancy

A

Ovulation stops during pregnancy
Corpus luteum continues to produce estrogen and progesterone
What is the corpus luteum?

As the placenta takes over secreting the hormones, the corpus luteum will begin to regress and atrophy by the middle of the pregnancy.

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25
Q

Uterus

A

The uterus grows in size to accommodate the growing fetus

Weight of the uterus grows from 60 grams (0.13lbs) to 1100 grams (2.4lbs)

The capacity of the uterus grows from holding about 10 ml to about 1500 ml

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26
Q

Uterus (cont)

A

Before pregnancy:
> Uterus measures 7.5 x 5 x 2.5 cm

At the end of the pregnancy:
> Uterus measures 28 x 23 x 21 cm

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27
Q

Uterus (more)

A

12 weeks - 14 weeks of gestation:
Palpated right above the symphysis pubis
Size of a grapefruit

20 - 24 weeks gestation:
The uterus is about the level of the umbilicus

36 weeks gestation
Touches xiphoid process

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28
Q

Uterus

A

38–40 weeks gestation (approximately)

> Lightening

> > Height drops as the fetus settles into the pelvis

> > Usually felt about two weeks before the term for primigravida pts

> > May not occur until the morning of the birth for multiparas.

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29
Q

Uterine Blood Flow

A

Increases during pregnancy to meet the requirement of the placenta

Before pregnancy:
Uterine blood flow is the rate of
15–20 ml/min

End of pregnancy:
500–750 ml/min

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30
Q

Hegar’s sign

A

It occurs during the first trimester

Softening of the isthmus of the uterus
Area between the cervix and the body of the uterus
Feels as thin as tissue paper

The bimanual exam will reveal Hegar’s sign

*Softening of the lower uterine segment

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31
Q

Braxton Hicks Contraction

A

Uterine contractions

Start after the fourth month of pregnancy.

Present throughout the pregnancy, become harder as the pregnancy advances
»After the 28th week, they get much harder

The monitor would pick them up, but the mom may not notice them

32
Q

Braxton Hicks Contraction

A

> May be confused with real labor due to the discomfort

> Do not cause cervical changes

> Do not increase in intensity or frequency

33
Q

Cervix

A

> Increased levels of Estrogen:

> > Stimulates the glandular tissue of the cervix to secrete a thick mucus

> > This thick mucus accumulates and forms the ____________ (mucus plug)

<Mucus>>Mucus plug is expelled when cervical dilation begins

>>Cervix forms protective \_\_\_\_\_\_\_\_\_ for fetus
barrier for fetus
</Mucus>

34
Q

Goodell Sign

A

> Softening of the cervix
Noticeable during the first 3 months

> > Caused by an increased level of estrogen
This leads the cervix to be more vascular and edematous

35
Q

Chadwick’s Sign

A

> Violet or bluish discoloration of the vaginal mucous membrane and cervix

> Noticeable during the first 3 months

> Due to the increased vascularity

36
Q

Ballottement

A

> Passive movement of the unengaged fetus

> Can be identified between the 16th and 18th week

> The technique of palpating a floating structure by bouncing it gently and feeling it rebound

> Place a finger in the vagina and tap gently upward, causing the fetus to rise.

> The examiner will feel the fetus rise, then rebound back.

37
Q

Vagina

A

> Increase in estrogen causes:

> > A thickening of the wall of the vaginal mucosa
Connective tissue to loosen
Increase in vaginal secretions
____________
>White mucus discharge with a faint, musty odor
Not pruritic
Not blood stained

38
Q

Vagina

A

> The pH of the vagina becomes more acidic

> This Acidic pH helps to prevent bacterial infection but favors yeast

> Increase in blood perfusion to the vagina
Chadwick’s sign is present in the vagina and the cervix

39
Q

Breasts & Pregnancy

A

> Increase in Estrogen and Progesterone:

> > Cause changes in the mammary glands
Breasts enlarge

> > One of the _____ symptoms of pregnancy
(about 6 weeks)

> Glands increase in size and number
Superficial veins become more prominent

40
Q

Breast

A

> Nipples become more erectile

> Areolas darken

> Montgomery’s follicles enlarge
>Sebaceous glands

> Striae may develop
>Stretch marks

40
Q

Breast

A

Colostrum is present during the second and third trimester

Possibly as early as the 16th week
Antibody-rich yellow secretion

Gradually converts to mature milk during the first few days after childbirth.

41
Q

Respiratory System

A

The volume of air breathed/min. Increases 30% - 40% in pregnancy.

To meet increased oxygen requirements

Progesterone decreases airway resistance–

Permits 20-40% increase in oxygen consumption

_______ stuffiness or congestion

42
Q

Respiratory

A

As the uterus enlarges, it presses upward and elevates the diaphragm.

The anterior-posterior diameter of the rib cage expands by as much as 6 cm.

No significant loss of intrathoracic volume

Breathing changes from abdominal to thoracic.

43
Q

Respiratory

A

> Enlarged uterus presses upward & elevates diaphragm–SOB

> Anterior-posterior diameter of the rib cage expands up to 6 cm

> No significant loss of intrathoracic volume

> Breathing changes from abdominal to thoracic

> When ___________ occurs, the difficulty breathing will get better!

44
Q

Temperature and Evolution

A

> During the period when the corpus luteum is so active, the temperature will rise slightly

> As the placenta takes over the function of hormone production, the temp will return to normal

> This rise in temp will occur along the same time as the ______ __________!

44
Q

Cardiovascular System

A

> Blood Volume
>Progressively increases beginning in the 1st trimester
»To provide nourishment for the placenta and to compensate for blood loss during delivery

> Increases rapidly in 2nd trimester
> Blood volume will increase by 40–50% during pregnancy

> Peaks in the third trimester, about 32 weeks
Bleeding Gums are common

45
Q

Cardiovascular System

A

> Red Blood Cell mass will increase by 20-30%
> Needed to carry additional oxygen

> Plasma volume increases by about 50%

> Physiologic ________ of Pregnancy:
>Plasma increases more than erythrocytes
>Thus, the H & H will decrease by 7% when looking at the serum level

> > > Due to hemodilution

46
Q

Iron Supplements

A

Needed by most women

Usually, they don’t have enough iron stored for reserve.

The fetus requires 350–400 mg of iron.

An increase in circulating red blood cells needs additional iron.

Prevent anemia with early dx & early tx through prenatal visits.

47
Q

Cardiac Output

A

> Increases by 30 – 50%

Heart rate
> Increases by 10 to 15 beats per minute

> The woman with a normal good heart will be able to handle this increased workload of the heart, but a woman with a weak heart will have an _________ in cardiac problems

48
Q

Heart Murmur

A

Benign

> Due to the diaphragm pushing upwards and the increase in blood volume

> As the diaphragm pushes upward, it will shift the heart’s position

49
Q

Leukocytes

A

> Leukocyte production increases slightly during pregnancy
5,000–15,000/mm

> During labor and early postpartum
25, 000 or higher

50
Q

Third Trimester

A

Blood flow to the lower extremities is often impaired by the pressure of the expanding uterus on veins and arteries

This leads to edema and varicose veins of the vulva, rectum and legs

51
Q

Blood Pressure

A

Despite the increase in blood volume, the BP does not usually _________

Slight ___________ in second trimester

Return to pre-pregnancy level by the third trimester

The increased heart rate compensates for the blood volume increase.

52
Q

Supine Hypotensive Syndrome

A

> An enlarged uterus may press on the vena cava and the aorta.

> Reduces blood flow to the right atrium
___________ blood pressure, causes dizziness…

> Will also reduce blood flow to the ___________

> Avoid laying supine!

53
Q

Gastrointestinal System

A

> Nausea and Vomiting

> Common during the first trimester

> Due to rising HCG levels and lowering Blood Glucose levels

> Typically occurs from 4 weeks – 12 weeks

> Delayed Gastric Emptying Time and peristalsis

> Due to smooth muscle relaxation from elevated _____________ levels

> Results in bloating and _____________

54
Q

GI System

A

Gums

> Hyperemic
Tend to bleed easily

Heartburn and flatulence
> Caused by the uterus growing and displacing the stomach and the intestines

> The Cardiac Sphincter also relaxes, which contributes to heartburn

Delayed gastric emptying and decreased peristalsis
> Caused by increased progesterone production, which decreases the tone and motility of smooth muscles.

55
Q

Metabolism

A

Increases during pregnancy
Changes in metabolism are due to the increased demand of the growing fetus
Returns to pre-pregnancy levels about 5 – 6 days after delivery

56
Q

Weight Gain

A

Recommended weight gain for women of normal pre-pregnancy weight is _________pounds

For women who were overweight, the recommended weight gain is __________ pounds.

For underweight women, they are advised to gain the weight needed to reach their ideal weight, plus __________ pounds

57
Q

Urinary Frequency

A

During 1st & 3rd trimester, _______ is pressing into pelvic organs
During 2nd trimester, the uterus is growing into the abdominal area

58
Q

Urine Output

A

Increases about 60 – 80% because the kidneys are excreting waste from the woman and the fetus

Glucosuria
Trace amounts of glucose may spill into the urine due to the kidneys inability to filtrate all of the glucose.
More than ____________ is abnormal

59
Q

Urinary System

A

> Larger amount of urine is held in the kidneys and ureters.

> Urine flow rate is decreased, leading to urinary stasis

> Bladder capacity increases to 1500ml because bladder tone decreases.

> All of these changes lead to an increase risk of UTI and Pyelonephritis

60
Q

Striae Gravidarum

A

AKA Stretch marks

> Abdomen, thighs, buttocks and breasts
Pink or red color during pregnancy
Will turn a silvery color after delivery

60
Q

Facial Chloasma or melasma gravidarum

A

Also called the “mask of pregnancy.”
Darkening of skin over the forehead and around the eyes
Will subside after childbirth

61
Q

Integumentary System

A

Changes in skin pigmentation is common

Overactive sweat glands also common

Due to increased estrogen, progesterone and melanotropin

62
Q

Musculoskeletal System

A

Calcium and Phosphorus needs are increased to allow the fetal skeleton to form.

Pelvic ligaments and joints gradually soften during pregnancy to allow for extension.

Causes a waddling gait

63
Q

Lumbar Lordosis

A

Lumbar spine curves to compensate for the increased weight of the uterus anteriorly

Results in low backaches

64
Q

Rectus Abdominis Muscles

A

Rectus Abdominis muscles of the abdominal wall stretch and lose some tone

Muscles may separate during 3rd trimester

After birth, the muscles gradually regain some tone.

65
Q

Endocrine System

A

> Placenta
Considered an endocrine organ
Formed during pregnancy

> It is classified an endocrine organ because it creates hormones

> > Estrogen and Progesterone
Human Chorionic gonadotropin
Human chorionic somatomammotropin

65
Q

Thyroid

A

Enlarges slightly due to increased vascularity
The level of T4 increases beginning at 6-9 weeks. Plateaus at 18 weeks

Metabolic rate increases by as much as 25% during pregnancy

Thyroid function will return to normal immediately after birth

66
Q

Anterior/Posterior Pituitary

A

Anterior Pituitary
Decreased production of FSH & LH
Increased production of Prolactin & Growth Hormone

Posterior Pituitary
Increased production of oxytocin throughout the pregnancy
Stimulates uterine contractions and stimulates ejection of milk
letdown reflex

67
Q

Adrenal Glands

A

Increase release of Cortisol
Cortisol levels return to normal 1 – 6 weeks post partum

Increase in aldosterone
Results in an increase in reabsorption of potassium

68
Q

Signs of Pregnancy

A

Categorized as:

> Presumptive
- Changes felt by the woman

> Probable
- Changes observed by an examiner

> Positive
- Those that can be attributed only to the presence of a fetus

69
Q

Presumptive Changes

A

Breast Changes

Amenorrhea

Nausea and vomiting

Excessive fatigue

Urinary Frequency

Nasal Stuffiness

Mood swings

Quickening
- Occurs about 16-20 weeks

70
Q

Probable Changes

A

Do not confirm pregnancy

  1. Changes in pelvic organs
    Goodell’s sign
    Chadwick’s sign
  2. ________________________
    Detects HCG in the urine/serum
71
Q

Probably Changes

A

General enlargement of the uterus after 8 weeks of pregnancy

Ballottement
Via vaginal exam

Braxton Hicks Contractions
Palpated after the 28th week

Skin pigment changes
Areola, linea nigra, facial melasma…

72
Q

Positive Changes

A

Cannot be confused with any other pathological state

Conclusive proof of pregnancy

_______ ______________
Heard with Doppler at about 14-16 weeks
As early as 6 weeks via U/S

73
Q

Positive Changes

A

Fetal movement
Palpated by a ______ _____________after about the 20th week

Visualization of the fetus
Via ____________________
As early as 5 - 6 weeks to detect fetal parts

OB 312 (2 decks)

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